ergoline and Central-Nervous-System-Cysts

Topics: Acromegaly; Adult; Antineoplastic Agents; Cabergoline; Central Nervous System Cysts; Ergolines; Female; Human Growth Hormone; Humans; Magnetic Resonance Imaging; Neurofibromatosis 1; Pituitary Gland; Pituitary Neoplasms

Cluster headache is classified as a primary headache by definition not caused by an underlying pathology. However, symptomatic cases of otherwise typical cluster headache have been reported.. A 47-year-old male suffered from primary chronic cluster headache (CCH, ICHD-3 beta criteria fulfilled) since the age of 35 years. A magnetic resonance imaging (MRI) study of the brain in 2006 came back normal. He tried several prophylactic treatments but was never longer than 1 month without attacks. He was under chronic treatment with verapamil with only a limited effect on the attack frequency. Subcutaneous sumatriptan 6 mg injections were very effective in aborting attacks. By February 2014 the patient developed a continuous interictal pain ipsilateral to the right-sided cluster headache attacks. An indomethacin test (up to 225 mg/day orally) was negative. Because of the change in headache pattern we performed a new brain MRI, which showed a cystic structure in the pituitary gland. The differential diagnosis was between a Rathke cleft cyst and a cystic adenoma. Pituitary function tests showed an elevated serum prolactin level. A dopamine agonist (cabergoline) was started and the headache subsided completely. Potential pathophysiological mechanisms of pituitary tumor-associated headache are discussed.. Neuroimaging should be considered in all patients with CCH, especially those with an atypical presentation or evolution. Response to acute treatment does not exclude a secondary form of cluster headache. There may be shared pathophysiological mechanisms of primary and secondary cluster headache.

Topics: Adenoma; Cabergoline; Central Nervous System Cysts; Cluster Headache; Diagnosis, Differential; Dopamine Agonists; Ergolines; Humans; Magnetic Resonance Imaging; Male; Middle Aged; Pituitary Gland; Pituitary Neoplasms; Sumatriptan; Treatment Outcome; Verapamil

Topics: Adolescent; Cabergoline; Central Nervous System Cysts; Dopamine Agonists; Ergolines; Female; Headache; Humans; Hyperprolactinemia; Treatment Outcome